Healthcare Provider Details

I. General information

NPI: 1033691563
Provider Name (Legal Business Name): AMBER N EADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 SMOKETREE CIR
APOPKA FL
32712-8175
US

IV. Provider business mailing address

1930 SMOKETREE CIR
APOPKA FL
32712-8175
US

V. Phone/Fax

Practice location:
  • Phone: 321-438-8041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5233824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: